Aneurysm Coiling Protocol

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Center for Brain Aneurysm Care
Aneurysm Coiling Protocol

This is a treatment protocol and guideline for aneurysm coiling used by our center.

Prior to procedure

• Each patient should have a baseline head CT or MRI within the last 3 to 6 months prior to intervention.
• Each patient should be given at least one dose of aspirin 81 or 325 mg, either the morning of the procedure, or the day before. If a stent-assisted coiling placement is envisioned, then aspirin 81 mg po qd AND clopidogrel 75 mg po qd should also be given for at least 3 to 5 days prior to the procedure. If the patient was not given the clopidogrel, or did not take the medication, then a loading dose of clopidogrel 300 mg po qd may be administered prior to procedure.

Post procedure

• Head CT (no contrast) on every patient the next day to look for silent ischemic complications from intervention.
• If patient had a stent placed, patient would be discharged on asa 81 mg po qd and clopidogrel 75 mg po qd x 3 months. After 3 months, d/c clopidogrel and continue aspirin indefinitely. Otherwise, no antiplatelet medications required unless otherwise specified by interventionalist.
• Discharge patient at 24 hours.
• Follow-up with neurointerventionalist at 1 to 3 month clinic follow-up. Neurointerventional team will assess for cerebrovascular risk factors at f/u and modification as necessary. MRA or angiogram to be scheduled in 6-12 months.

Long-term angiographic follow-up of aneurysm

• 6 months, 18 months, 3 years, 5 years, 10 years

Ruptured Aneurysm

Post procedure

• Begin heparin s/c in ICU 12 hours after procedure (unless otherwise specified by interventionalist).
• Supplemental ASA will be advised to team at the discretion of neurointerventionalist (in general, additional antiplatelet therapy is not needed, unless there was a large aneurysm with large coil mass, or wide neck aneurysm).
• Head CT (no contrast) on every patient the next day to look for silent ischemic complications from intervention.

At Discharge

• Follow-up with neurointerventionalist at 2 to 3 month clinic follow-up (INR team will ask Nidia Ferreira to schedule).
• Neurointerventional team will assess for cerebrovascular risk factors at f/u and modification as necessary. Smoking cessation will be emphasized.
• MRA 3D TOF or catheter angiogram to be scheduled at 6-12 months.

Long-term angiographic follow-up of aneurysm

• 6 months, 18 months, 3 years, 5 years, 10 years
• If patient is difficult access or high risk for angiography, then 3D MRA with TOF
• If evidence of recanalization, then angiograms may be scheduled at a closer

References

Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-403.